Bipolar Disorder Clinical Trial
Official title:
Study of Predictor of Mood Relapse in Bipolar Disorders : Prospective, Clinical, Neuropsychological, Biological and Genetic Study
Study in 400 patients with bipolar disorder I or II, of relapse risk factors. The principal
objective of this research is to test the predictive value of core vulnerability dimensions
such as affective instability and emotional reactivity, measured by validated questionnaires
(AIM and ALS) on recurrence of affective major episode (depressed, hypomanic or manic)
during a 24 months prospective follow-up.
In addition, several arguments suggest that inter-individual variability in the risk of
relapse is influenced by genetic factors. In particular, the implication of such factors
have been demonstrated in rapid cycling or antidepressants induced mania. However, this has
never been tested in cohorts followed prospectively. Finally, the existence of
neuropsychological deficits in bipolar disorder is well documented and their role in the
risk of relapse is suspected. Yet the nature of these deficits, their origin and
evolutionary course remain poorly investigated. In summary, the secondary objectives of this
research are the study of the influence of these other clinical, neuropsychological and
genetic factors on the risk of relapse.
• Scientific rationale The dimensions of affective instability and emotional reactivity, are
considered core psychological and temperamental vulnerability dimensions to bipolar
disorder. Differences in levels of instability and reactivity may account for the
inter-individual variability observed in bipolar disorder in terms of risk of relapse. These
dimensions are measured using validated questionnaires (Affective Instability Measure (AIM)
and Affective Lability Scale (ALS)). Relapsing is defined as the occurrence of a depressive
episode, hypomanic, manic or mixed episode (DSMIV criteria).
Other factors that may influence the risk of relapse have been suggested in the literature
but have not been formally tested in prospective studies:
1. cognitive deficits: the existence of neuropsychological deficits in bipolar disorder
are well documented and their role in the risk of relapse is suspected. Yet the nature
of these deficits, their origin and their course remain poorly investigated. Indeed,
some appear to be related to the neurotoxicity of the episodes themselves, the other
being related to the vulnerability to bipolar disorder
2. The involvement of genetic vulnerability factors in bipolar disorder is widely
demonstrated. Several arguments suggest the implication of genetic factors in the risk
of relapse. This is the case for some outcome patterns such as rapid cycling or
antidepressants induced mania. Again, this has never been tested in cohorts followed
prospectively.
3. The role of certain inflammatory and infectious factors in the etiology of bipolar
disorder has been suggested but it is clear whether these biomarkers are "state" or
"traits". Thus, the role of neurotoxic inflammatory or infectious factors in relapse
mood has never been tested in a prospective follow up studies.
- Main objective of the project To determine if the scores of AIM and ALS, assessed
at baseline in euthymic bipolar patients is associated with relapse in patients
during a 2 years follow-up period.
- Secondary objectives of the project Determine if the neuropsychological
performance at T0, measured in euthymic patients predict relapse during a 2 years
follow-up period.
Determine whether the neuropsychological deficits observed in euthymic bipolar patients that
contribute to functional impairment worsen with time.
DNA collection to test the involvement of candidate genes Serum collection to study the
biological and infectious biomarkers
• Methodology Prospective follow up studies. Multicenter.
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